Diagnostic Imaging Pathways - Temporomandibular Joint Disorders
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This pathway provides guidance on the imaging of adult patients with suspected temporomandibular joint disorders.
Date reviewed: August 2013
Date of next review: August 2015
Published: May 2013
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|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- A term used to describe many conditions that cause pain and dysfunction of the Temporomandibular Joint (TMJ) and structures related to mastication
- Only patients with clinical evidence of significant TMJ disease or a lack of response to conservative management should have an OPG
- MRI is the modality of choice for the assessment of both soft and hard tissues of the TMJ
- Limited accuracy to detect intra-articular disc morphology and position, however studies using multi-detector CT have not been published ,
- For anterior displacement of the intra-articular disc CT has a sensitivity and specificity of 66% and 68% respectively. For sideways and rotational disc displacement the sensitivity and specificity is 64% and 83% respectively
- Not recommended as a first line investigation for TMJ disorders
- Good accuracy for diagnosing osseous abnormalities, including advanced degenerative joint disease and ankylosis
Magnetic Resonance Imaging
- Largely replaced arthrography as the imaging modality used to assess the location and morphology of the intra-articular disc
- Superior to radiography and computed tomography for soft tissue definition, and considered the modality of choice for assessing both soft and hard tissues of the TMJ
- MRI can detect anterior displacement of the intra-articular disc with a sensitivity and specificity of 86% and 63% respectively. For sideways and rotational disc displacement the sensitivity and specificity is 81% and 87% respectively
- Most studies are limited because surgery is not optimal as a gold standard due to the small surgical incision, and difficulties in observing medial and lateral disc displacement. A study of the accuracy of MRI for TMJ autopsy specimens revealed an accuracy of 95% for disc morphology and position, and 93% for osseous conditions ,
- Correlation with symptoms is essential, as TMJ disc displacement is present in up to 35% of asymptomatic individuals
Panoramic Radiography (OPG)
- Used to detect gross osseous abnormalities and dental disease
- Limited value for diagnosis of specific conditions causing temporomandibular joint dysfunction because mild degenerative disease is seen equally in symptomatic and asymptomatic people
- Not recommended as a routine investigation in all patients who present with TMJ symptoms. Only patients with clinical evidence of significant TMJ disease or a lack of response to conservative management should have an OPG
Temporomandibular Joint Disorder (TMJ)
- TMJ disorder is an umbrella term used to describe many conditions with differing aetiologies that cause pain and dysfunction of the TMJ and structures related to mastication
- It can be broadly categorised into 2 groups
- Intracapsular disorders: synovitis, osteoarthritis, inflammatory arthritides, and displacement of the articular disc
- Extracapsular disorders: myofascial pain involving the muscles of mastication, trigeminal neuralgia
Date of literature search: April 2013
The search methodology is available on request. Email
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Westesson P-L. Reliability and validity of imaging diagnosis of temporomandibular joint disorder. Adv Dent Res. 1993;7:137-51. (Review article)
- Scarfe WC. A common sense approach to TMJ and implant imaging. Ann Roy Australas Coll Dent Surg.1998;14:48-61. (Review article)
- Crow HC, Parks E, Campbell JH, Stucki DS, Daggy J. The utility of panoramic radiography in temporomandibular joint assessment. Dentomaxillofac Radiol. 2005;34:91-5. (Level III evidence)
- Epstein JB, Caldwell J, Black G. The utility of panoramic imaging of the temporomandibular joint in patients with temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:236-9. (Review article)
- Tognini F, Mandredini D, Melchiorre D, Bosco M. Comparison of ultrasonography and magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement. J Oral Rehabil. 2005;32:248-53. (Level III evidence)
- Liedberg J, Panmekiate S, Petersson A, Rohlin M. Evidence-based evaluation of three imaging methods for the temporomandibular disc. Dentomaxillofac Radiol. 1995;25:234-41. (Level II/III evidence)
- Tasaki MM, Westesson P-L. Temporomandibular joint: diagnostic accuracy with sagittal and coronal MR umaging. Radiology. 1993;186:723-9. (Level III evidence)
- Larheim RA, Westesson P-L, Sano T. Temporomandibular joint disk displacement: comparison in asymptomatic volunteers and patients. Radiology. 2001;218:428-32. (Level III evidence)
- Dixon DC. Radiographic diagnosis of temporomandibular disorders. Semin Orthod. 1995;1:207-21. (Review article)
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